- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.70 / $6,012.00 / $10,527.00
| Facility | | $1,275.70 | $6,012.00 | $10,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.86 / $1,175.08 / $1,473.83
| Professional | | $996.86 | $1,175.08 | $1,473.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.91 / $1,089.30 / $1,715.00
| Professional | | $925.91 | $1,089.30 | $1,715.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.78 / $1,423.29 / $2,187.48
| Professional | | $1,039.78 | $1,423.29 | $2,187.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.09 / $1,598.09 / $1,677.17
| Professional | | $1,598.09 | $1,598.09 | $1,677.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.70 / $6,832.00 / $12,181.00
| Facility | | $1,275.70 | $6,832.00 | $12,181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.86 / $1,288.47 / $5,958.00
| Professional | | $996.86 | $1,288.47 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $2,626.50
| Professional | | $10.00 | $10.00 | $2,626.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.00 / $1,462.50 / $2,284.32
| Professional | | $1,125.00 | $1,462.50 | $2,284.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.83 / $1,031.83 / $1,163.56
| Facility | | $1,031.83 | $1,031.83 | $1,163.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.50 / $1,050.98 / $1,163.56
| Professional | | $986.50 | $1,050.98 | $1,163.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.00 / $2,391.00 / $6,322.00
| Facility | | $656.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.84 / $1,435.89 / $2,154.03
| Professional | | $1,075.84 | $1,435.89 | $2,154.03 |